Non-invasive estimation of myocardial work by transthoracic echocardiography is a novel tool to analyse myocardial contraction efficiency during systole. Two methods are described, on using Left ventricular (LV) strain and a LV pressure estimation, and another with only LV strain integrals. The present study analyses their utility in prediction of CRT-response.

In total, 243 patients implanted by a CRT according to current recommendations were retrospectively included in hospital university of Rennes. All patients had a complete transthoracic echocardiography at implantation and at 6-moths follow-up. Responders were defined as having a 15% decrease in indexed LV end-systolic volume at follow-up compared to baseline. Baseline characteristics are described in Table 1; 25.1% were non-responders. In this group, there were more men, more ischemic cardiomyopathies with more dilated LV. Strain signals were analysed only in the most informative loop, the apical 4 cavities. Myocardial work estimation with LV pressure estimation was previously described. The 3 different integral of strain signal were represented in Fig. 1. According to ROC curves, myocardial work (particularly wasted work in septal wall with AUC=0.718±0.04) estimated with LV pressure estimation is better than strain integrals to predict LV positive remodelling (best AUC 0.631±0.040) after CRT-implantation.

Left ventricular pressure estimation give useful information on top of strain curves for prediction for CRT-response.